Provider Demographics
NPI:1396799904
Name:CALDERON, BENITO JR (MD)
Entity type:Individual
Prefix:MR
First Name:BENITO
Middle Name:
Last Name:CALDERON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 W CHARLESTON BLVD.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1906
Mailing Address - Country:US
Mailing Address - Phone:702-623-7205
Mailing Address - Fax:702-489-2417
Practice Address - Street 1:3000 W CHARLESTON BLVD.
Practice Address - Street 2:SUITE 5
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1906
Practice Address - Country:US
Practice Address - Phone:702-623-7205
Practice Address - Fax:702-489-2417
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine